What is the treatment for intertrigo?

Treatment of Intertrigo

The treatment of intertrigo requires keeping the affected area clean and dry, applying topical antifungal agents such as nystatin or azole creams for fungal infections, and using topical antibiotics for bacterial superinfections. 1, 2

Understanding Intertrigo

Intertrigo is a superficial inflammatory dermatitis occurring on two closely opposed skin surfaces due to moisture, friction, and lack of ventilation. It commonly affects:

• Intertriginous areas (skin folds)
• Areas where skin-to-skin contact occurs
• Regions prone to moisture accumulation

Physical examination typically reveals:

• Erythematous patches with peripheral scaling
• Possible maceration
• Satellite pustules (when Candida is involved)

Treatment Algorithm

Step 1: Address Underlying Factors

• Minimize moisture and friction in affected areas
• Encourage weight loss in obese patients
• Control blood glucose in diabetic patients
• Treat any underlying immunosuppressive conditions 3

Step 2: Basic Skin Care Measures

• Keep affected areas clean and thoroughly dry
• Use absorptive powders such as cornstarch
• Apply barrier creams to reduce friction
• Wear light, non-constricting, absorbent clothing
• Avoid wool and synthetic fibers 4

Step 3: Treat According to Causative Agent

For Fungal Intertrigo (especially Candida):

• Apply topical antifungals:
  • Nystatin cream for 7-14 days
  • Clotrimazole 1% cream 2-3 times daily for 2-4 weeks
  • Miconazole, ketoconazole, oxiconazole, or econazole creams 5, 1
• For resistant cases:
  • Oral fluconazole 150mg as a single dose or 100mg daily for 7-14 days 5, 3

For Bacterial Intertrigo:

• For streptococcal infections:
  • Topical mupirocin
  • Oral penicillin for extensive cases
• For Corynebacterium infections:
  • Oral erythromycin 1

For Mixed Infections:

• Combination therapy with antifungal and antibacterial agents
• Consider combination products containing both antifungal and mild corticosteroid for short-term use in inflamed areas

Prevention of Recurrence

1. Maintain proper hygiene and keep skin folds dry
2. Consider moisture-wicking textiles within skin folds 2
3. Shower after physical exercise and thoroughly dry intertriginous areas
4. Wear open-toed shoes for toe web intertrigo 4
5. Address predisposing factors (obesity, diabetes, etc.)

Common Pitfalls to Avoid

• Inadequate drying: Moisture promotes fungal growth and worsens intertrigo
• Premature discontinuation of treatment: Complete the full treatment course even if symptoms improve
• Misdiagnosis: Bacterial infections may mimic fungal infections; consider bacterial culture if not responding to antifungal treatment 5
• Overuse of corticosteroids: Can worsen fungal infections and cause skin atrophy
• Irritant antiseptics: May aggravate intertrigo and provoke allergic contact dermatitis 6

Special Considerations

• Diagnosis confirmation: For persistent cases, consider potassium hydroxide (KOH) preparation to identify fungal elements or bacterial culture 5, 1
• Recurrent cases: Investigate for underlying systemic conditions (diabetes, immunosuppression)
• Severe or extensive disease: Consider systemic therapy rather than topical treatments alone

The management of intertrigo requires addressing both the underlying causes and secondary infections. With proper treatment and preventive measures, most cases resolve completely, though recurrence is common if predisposing factors are not adequately addressed.